Telemedicine in Heart Failure: Studies of Treatment, Prognosis and Patient Experience

Heart failure (HF) affects 2% of the population, rising to 10% in individuals over 80 years, causing considerable healthcare costs and suffering. In newly diagnosed HF titration of medication to optimal medical therapy (OMT) usually requires multiple physical visits in specialized clinics. Recent advances have enabled telemonitoring, wireless transmission of sensor-generated health data as an alternative which need scientific evaluation.

HF is characterized by periods of stability followed by episodic deterioration, with reduced quality of life (QoL) and hospitalizations. Decline in vital signs appear long before symptoms occur, successively leading to a point when hospitalization cannot be avoided. Telemonitoring allows for consistent monitoring of vital parameters, which potentially may guide treatment and prevent hospitalizations. It also promotes patient empowerment and personalized treatment. The European Society of Cardiology's (ESC) guidelines for HF, 2021 calls for further research on real world telemedicine data to optimize patient selection, equipment, and protocols. The Swedish national HF register, SwedeHF, contains detailed data on the majority of acute HF patients, providing an excellent opportunity to generate a well characterized matched real world population, including yearly up-dates of clinical information. In addition, electronic health records (EHRs) are an increasingly important source for studies of routinely collected healthcare data, offering granular real world data for research and prognostic modeling.

Work plan: Can RPM/telemonitoring for HF provide effective, safe and cost-efficient care with high patient satisfaction? We will compare six months of telemonitoring intervention with standard care to study clinical outcomes, patient experience and health economics (data collection in progress).

Participants: Consecutive HF patients (≥18 years) at specialized HF clinics are being recruited for intervention. Inclusion criteria are new or worsening HF in patients requiring monitoring due to a) titration of medication to OMT or b) decompensation requiring regular physical monitoring.

Intervention: Patients receive equipment for report of vital signs and patient reported experience measures (PREMS), automatically transmitted via smartphone/bluetooth for six months (possible extension to 12 months in case of instability). A digital smartphone application is used for registration and transmission of data, including modes for asynchronous (chat) communication with the healthcare provider. Planned titration to OMT or diuretic adjustments may be done remotely depending on clinical assessment. The digital sensors include an electronic scale, pulse and blood pressure monitor for daily measurements by the patient. The healthcare provider is notified of abnormal values, with services provided during office hours. Physical visits will be planned on a need-to basis. A care plan for target OMT or adjustments of diuretic treatment is established.